First Nations and Inuit Home and Community Care Program - Biannual Report 2000-2002

Regional Overview

Ontario

Ontario Region Profile

Population: 77,879
Average Population per Community: 628
Number of Communities Eligible for Funding:124
Number of Communities Funded: 117
% of Needs Assessments Completed: 82 %
% of Communities with Submitted Plans: 63 %
% of Communities in Planning Implementation: 73% 46 %
% of Communities with Access to Service Delivery: 11 %
2001/02

Ontario Region is home to the largest population of First Nations persons in Canada and the second largest number of communities, after British Columbia.

Structure

In Ontario, Health Canada's First Nations and Inuit Health Branch (FNIHB) entered into an agreement with the Chiefs of Ontario. The Chiefs of Ontario, in turn, contracted to the various Provincial/Territorial Organizations. The Provincial/Territorial Organizations (PTOs) include:

• Association of Iroquois and Allied Indians
• Grand Council Treaty #3
• Independent First Nations
• Nishnawbe-Aski Nation (NAN)
• Union of Ontario Indians

In the fall of 2000, NAN, Grand Council Treaty #3, and 15 additional First Nations elected to work directly with FNIHB. The partnership consisted of a Program Manager with the Chiefs of Ontario assisting 38 First Nations, a Program Manager with FNIHB and Grand Council Treaty #3 assisting 51 First Nations, and a Program Manager with NAN assisting 35 First Nations.

Ontario PTOs

Association of Iroquois and Allied Indians (AIAI)

• Represents eight nations of status Indians in Ontario, with a collective membership of approximately 16,000

Independent First Nations

• Includes twelve nations in the province

Nishnawbe Aski Nation (NAN)

• Evolved out of Grand Council Treaty #9, which was established in 1973 as the Regional organization representing the interests of 49 First Nations in Northern Ontario who are signatories to Treaty No. 9 and Treaty No. 5 (in Ontario). In 1982, the name changed to Nishnawbe Aski Nation. The population is estimated at approximately 25,000

Grand Council Treaty #3

• Represents 28 nations in the NW part of the province

Union of Ontario Indians

• Represents 43 nations in southern Ontario Region with a population estimated at approximately 20,000

Program Overview: 2000/01 and 2001/02

During 2000/01, agreements were set up and peer review training sessions were held across the province. More than two-thirds of communities in Ontario are small, with a mix of communities going through Tribal Councils or running programs independently. The pace of program planning and implementation varied in each community throughout the province.

In 2001/02, efforts continued on working through the various phases of the First Nations and Inuit Home and Community Care (FNIHCC) implementation with communities working at their own pace. By year-end, most communities had completed a needs assessment and had submitted plans. Larger communities, such as the Mohawk Bay of Quinte near Belleville and the Algonquins of Golden Lake, tended to move through the process quicker than smaller communities did. In fact, although 11% of communities were at service delivery phase by the end of 2001/02 this represented almost 34% of the on-reserve population in Ontario.

While larger communities with greater capacity were more apt to move through the process quicker, some small communities moved quickly. With a nurse in place for the program to coordinate the northern regions, this part of the province tended to move more quickly than the southern areas.

During these two years, more and more agencies throughout the province began hearing about the Program and made inquiries on behalf of their clients. In some areas, nurses were contracted and undertook the responsibility of supervising personal support workers. In Ontario, Provincial funding was utilized by communities to augment the FNIHCC funding allocation. The combination helped to lay the foundation for obtaining essential and supportive elements. Some communities were hesitant to sharing provincial funding figures for fear of losing federal funding dollars through the FNIHCC Program.

Through the planning process and associated funding for planning, communities were able to identify gaps in capacity for training, capital, and home care services. A budget variance during this period enabled more money to go towards required training and medical supplies and equipment to support the program efforts.

First Nations coordinators met frequently to discuss issues and brainstorm challenges. Workshops were conducted across the province to discuss the program and associated options and parameters.

Training

In 2001/02, the Northern Training Plan was submitted and received approval for 80% of funds. The Southern Training Plan was also submitted and received the remaining 20% of funds.

Some of the training that took place in the Ontario Region during this period included:

• skills development training for health directors;
• training personal support workers across the province; and
• foot care and dementia courses for nurses

According to program tracking data, the number of personal support workers in communities prior to the program was 167. Training plans indicate this figure would increase to 257 through program funding. The number of Licensed Practical Nurses (LPNs) for home care would increase from zero to 10 and the number of home care Registered Nurses (RNs) would increase from 4 to 40.

Partnerships

Following are examples of partnerships fostered during the first two years of the program.

First Nations

• The FNIHCC Program was planned and implemented in close consultation with the Chiefs of Ontario and the five Provincial/Territorial Organizations (PTOs), which include the Association of Iroquois and Allied Indians, First Nations of Treaty 3, Independent First Nations, Nishnawbe-Aski Nation (NAN) and the Union of Ontario Indians.

Education and Training

• Area coordinators worked with community colleges and organizations such as the Ontario Community Support Association and the Red Cross to develop training programs. These programs included training within some communities, at Regional colleges, or online training. The Ministry of Health and Long Term Care and FNIHB combined funding to increase training funds so that additional homemakers could be trained as personal support workers.

Provincial

• The Ontario Ministry of Health and Long Term Care did have some funding for home care on reserve and opportunities for linking were sought. For example, this funding provided some resources for homemaker services (cleaning, etc.) and discussions were held to look at upgrading skills to become personal support workers.

• Linkages were made with the provincial nursing program in Ontario and meetings were held to share information.

• The Province also coordinates 43 Community Care Access Centres (CCACs) across Ontario. While not First Nations-specific, communities can access the centres when applicable.

The CCACs provide a simplified service access point and are responsible for:

• determining eligibility for, and buying on behalf of consumers highest quality best priced visiting professional and homemaker services provided at home and in publicly-funded schools;

• determining eligibility for, and authorizing all admissions all long-term care facilities (nursing homes and homes for the aged);

• service planning and case management for each client; and

• providing information on and referral to all other long-term care services, including volunteer-based community services.

Program Linkages

Across the country, Regions linked with other federal agencies and programs, where possible. In Ontario, this included working with Indian and Northern Affairs Canada (INAC), specifically with respect to the Department's Adult Care Program (in-home component).

Resources Developed/Distributed

Resources distributed included the following publications:

• Ontario Community Support Association
• Managing Risk
• Evaluation Handbook
• Becoming a Personal Support Worker
• Standards and Indicators for Personal Support and Homemaking Services
• Provincial Standards and Guidelines for Case Management
• FNIHCC Program Policy and Procedures Manual Template
• College of Nurses of Ontario Compendium of Standards of Practice for Nurses in Ontario

Some First Nations requested and received the Ontario Region Nursing Policy and Practice Manual, which is geared to Community Health Nurses Tuberculosis Manual. Information was also established on the Chiefs of Ontario website and updated monthly.